Medicare Secondary Payer Update

Thoughtware Alert Oct 16, 2020
Long-Term Care Professional Holding Patient's Hand

On September 15, 2020, the U.S. Department of Health & Human Services (HHS) along with CMS published Transmittal 10359. This transmittal includes an update to the model questions for providers to ask Medicare beneficiaries related to Medicare Secondary Payer coverage. These changes are effective December 7, 2020.

Prior to submitting a claim to Medicare, providers are required to verify Medicare is the primary payor for each inpatient admission and outpatient encounter. To accomplish this, providers ask a series of questions to determine if any other payors are primary to Medicare. CMS recently updated and streamlined these questions. It’s common for providers to develop a form outlining the model questions to be completed and retained for each admission or outpatient encounter. 

CMS doesn’t require a standard form or signature from the beneficiary, but it’s recommended that providers document the date the questions were asked. Providers also should retain copies of any eligibility information, such as a 271 response or common working file, to support they have a process for verifying coverage upon each admission. These supporting documents should be retained for a minimum of 10 years. Documents can be obtained on paper, as optical images, or on microfile or microfiche. It’s a best practice to scan these documents into the electronic health record and attach to each patient profile so they can be easily retrieved when needed. 

To assist providers in developing or revising an admission questionnaire, we have included a tool with this article. 

Take Questionnaire 
 
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